Surgical treatment of hepatocellular carcinoma

Substantial advances and standardization in hepatobiliary operative procedures in the last two decades have led to a significant decrease in perioperative morbidity and mortality after resection also of large liver tumors. Therefore, primary resectable hepatocellular carcinoma (HCC) should primarily be resected. Most patients with stable health status without cirrhosis or with Child A cirrhosis qualify for resection. It is of utmost importance that resectability is evaluated in a designated liver center. Intrahepatic tumor recurrences also can be re-resected or in selected cases listed for liver transplantation. Liv-er transplantation is currently the standard therapy for not too advanced HCC in cirrhosis. By observing selection criteria 5-year survival rates of 70-90% can be achieved. Patients listed for liver transplantation require bridging therapy with either resection, radio-frequency ablation or transarterial chemoembolization.